PSYCHODERMATOLOGY – FOCUS ON PSYCHIATRIC OUTCOMES OF THERMAL SKIN INJURIES
Keywords:
psihodermatološki poremećaji, termičke povrede kože, mentalno zdravlje
Abstract
Psychodermatology represents the discipline that explores the complex interaction between the central nervous system and the skin and offers a lot of confirmations for bidirectional interconnection between the pathological alterations that affect both the skin and nervous system. Psychodermatological disorders can be classified into three principal groups: Psychophysiological disorders, Psychiatric disorders with dermatological symptoms, and Dermatological disorders with psychiatric symptoms, while other entities that appear in clinical practice are classified as Miscellaneous. Thermal skin injuries are classified in the category of dermatitis artefacta. It has been confirmed that burns do not affect somatic health components only, but also have a deep impact on the patient’s mental health and overall quality of life. Severe thermal skin injuries have been shown to also exert a significant systemic response that is finally accompanied by a visible impact on mental health. The major groups of markers that show the common type of alterations that connect cutaneous events (typical for thermal injury) and mental outcomes accompanied by burns are oxidative stress and inflammation markers, neurotransmitters, and neurotrophin system elements. The aim of this literature overview was to summarize some specific clinical entities for psychiatric/dermatological disorders that share the same underlying pathophysiological mechanisms, especially from the rarely evaluated direction (“skin to brain”) – psychiatric outcomes of thermal skin injuries.
References
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29. Mulder PPG, Vlig M, Fasse E et al. Burn-injured skin is marked by a prolonged local acute inflammatory response of innate immune cells and pro-inflammatory cytokines. Front Immunol. 2022; 13: 1034420.
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31. Dahiya P. Burns as a model of SIRS. Front Biosci (Landmark Ed) 2009; 14(13): 4962-7.
32. Flierl MA, Stahel PF, Touban BM et al. Bench-to-bedside review: Burn-induced cerebral inflammation--a neglected entity? Crit Care 2009; 13(3): 215.
33. Sharma JN, Al-Omran A, Parvathy SS. Role of nitric oxide in inflammatory diseases. Inflammopharmacology 2007;15(6): 252-9.
34. Paul V, Ekambaram P. Involvement of nitric oxide in learning & memory processes. Indian J Med Res. 2011; 133(5): 471-8.
35. Bahdar ZI, Abu-El-Rub E, Almazari R, Alzu'bi A, Al-Zoubi RM. The molecular mechanism of nitric oxide in memory consolidation and its role in the pathogenesis of memory-related disorders. Neurogenetics 2025; 26(1): 22.
36. Susswein AJ, Katzoff A, Miller N, Hurwitz I. Nitric oxide and memory. Neuroscientist 2004; 10(2): 153-62.
37. Chapman PF, Atkins CM, Allen MT, Haley JE, Steinmetz JE. Inhibition of nitric oxide synthesis impairs two different forms of learning. Neuroreport. 1992; 3(7): 567-70.
38. Halm MP, Poquin D, Lestaevel P, Chancerelle Y, Graff C. Brain and cognitive impairments from burn injury in rats. Burns 2006; 32(5): 570-6.
39. Purohit M, Goldstein R, Nadler D et al. Cognition in patients with burn injury in the inpatient rehabilitation population. Arch Phys Med Rehabil. 2014; 95(7): 1342-9.
40. Pandharipande PP, Girard TD, Jackson JC et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013; 369(14): 1306-16.
41. Gupta D, Kaushik D, Mohan V. Role of neurotransmitters in the regulation of cutaneous wound healing. Exp Brain Res. 2022; 240(6): 1649-59.
42. Sadiq A, Shah A, Jeschke MG et al. The Role of Serotonin during Skin Healing in Post-Thermal Injury. Int J Mol Sci. 2018; 19(4): 1034.
43. Chance WT, Berlatzky Y, Minnema K, Trocki O, Alexander JW, Fischer JE. Burn trauma induces anorexia and aberrations in CNS amine neurotransmitters. J Trauma 1985; 25(6): 501-7.
44. Wang Z, Chen L, Rong X, Wang X. Upregulation of MAOA in the hippocampus results in delayed depressive-like behaviors in burn mice. Burns 2017; S0305-4179(17): 30165–1.
45. Krstic M, Jovicic N, Selakovic D et al. Simultaneous Administration of Hyperbaric Oxygen Therapy and Antioxidant Supplementation with Filipendula ulmaria Extract in the Treatment of Thermal Skin Injuries Alters Nociceptive Signalling and Wound Healing. Medicina (Kaunas) 2023; 59(9): 1676.
46. Cramer SC, Sur M, Dobkin BH et al. Harnessing neuroplasticity for clinical applications. Brain. 2011; 134(Pt 6): 1591-609.
47. Zhang QH, Hao JW, Li GL, Ji XJ, Zhou M, Yao YM. Long-lasting neurobehavioral alterations in burn-injured mice resembling post-traumatic stress disorder in humans. Exp Neurol. 2020; 323: 113084.
48. Bramham CR, Messaoudi E. BDNF function in adult synaptic plasticity: the synaptic consolidation hypothesis. Prog Neurobiol. 2005; 76(2): 99-125.
49. Calabrese F, Rossetti AC, Racagni G, Gass P, Riva MA, Molteni R. Brain-derived neurotrophic factor: a bridge between inflammation and neuroplasticity. Front Cell Neurosci. 2014; 8: 430.
50. Guan Z, Fang J. Peripheral immune activation by lipopolysaccharide decreases neurotrophins in the cortex and hippocampus in rats. Brain Behav Immun. 2006; 20(1): 64-71.
2. Savin JA, Cotterill JA. Psychocutaneous disorders. In: Champion RH, Burton JL, Ebling FJG, eds. Textbook of Dermatology. Oxford, England: Blackwell Scientific Publications; 1992; 2479–96.
3. Humphreys F, Humphreys MS.. Psychiatric morbidity and skin disease: what dermatologists think they see. Br J Dermatol. 1998; 139: 679–681.
4. Garg A, Chren MM, Sands LP, Matsui MS, Marenus KD, Feingold KR, Elias PM. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001; 137(1): 53-9.
5. Slominski A. Neuroendocrine system of the skin. Dermatology. 2005; 211(3): 199-208.
6. Torales J, Martino B D, Psychodermatology: mind the skin. Telangana J Psychiatry 2016; 2(1): 5-7.
7. Koo JY and Lee CS. General Approach to Evaluating Psychodermatological Disorders. In: Koo JY and Lee CS, Eds., Psychocutaneous Medicine, Marcell Dekker, Inc, New York, 2003: 1-29.
8. Patel A, Jafferany M. Multidisciplinary and Holistic Models of Care for Patients With Dermatologic Disease and Psychosocial Comorbidity: A Systematic Review. JAMA Dermatol. 2020; 156(6): 686–94.
9. Graubard R, Perez-Sanchez A, Katta R. Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology. Dermatology practical & conceptual 2021; 11(4): e2021091.
10. Lockwood K, Smith K, Taylor R, Ahmed A. Suicidal behaviour in psychodermatology patients: Identifying characteristics and a new model for referral. Skin health and disease 2023; 3(4): e207.
11. Tohid H, Shenefelt PD, Burney WA, Aqeel N. Psychodermatology: An Association of Primary Psychiatric Disorders With Skin. Revista Colombiana de psiquiatria (English ed.) 2019; 48(1): 50–7.
12. Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. The British journal of dermatology 2000; 143(5): 983–91.
13. Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. American journal of clinical dermatology 2003; 4(12): 833–842.
14. Kumar N, Sharma S, Kapoor V. Adverse Drug Events in Patients with Mental Disorder in an Ambulatory Setting. International journal of applied & basic medical research 2017; 7(2): 108–11.
15. Jafferany M, Bhattacharya G. Psychogenic Purpura (Gardner-Diamond Syndrome). The primary care companion for CNS disorders 2015; 17(1): 10.4088/PCC.14br01697.
16. Jafferany, M. Cutaneous Sensory Syndromes. In: Handbook of Psychodermatology. Springer, Cham., 2022. https://doi.org/10.1007/978-3-030-90916-1_7
17. Brink C, Isaacs Q, Scriba MF, Nathire MEH, Rode H., Martinez R. Infant burns: A single institution retrospective review. Burns: journal of the International Society for Burn Injuries 2019; 45(7): 1518–27.
18. Ademola SA, Michael AI, Iyun AO et al. Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria. Journal of burn care & research: official publication of the American Burn Association 2024; 45(1): 190–9.
19. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers 2020; 6(1): 11.
20. Krstic B, Selakovic D, Jovicic N et al. Complex Hippocampal Response to Thermal Skin Injury and Protocols with Hyperbaric Oxygen Therapy and Filipendula ulmaria Extract in Rats. Int J Mol Sci. 2024; 25(5): 3033.
21. Fauerbach JA, Lawrence J, Haythornthwaite J et al. Preburn psychiatric history affects posttrauma morbidity. Psychosomatics 1997; 38(4): 374–85.
22. Perry S, Difede J, Musngi G, Frances AJ, Jacobsberg L. Predictors of posttraumatic stress disorder after burn injury. Am J Psychiatry 1992; 149(7): 931–5.
23. Perez Jimenez JP, Gomez Bajo GJ, Lopez Castillo JJ, Salvador- Robert M, Garcia Torres V. Psychiatric consultation and post-traumatic stress disorder in burned patients. Burns 1994; 20(6): 532–6.
24. Alyafi T, Al-Marzouki AH, Al Hassani AN. Therapeutic Outcome of Burn Patients Treated With Hyperbaric Oxygen. Cureus 2021; 13(10): e18671.
25. Oldham KT, Guice KS, Till GO, Ward PA. Activation of complement by hydroxyl radical in thermal injury. Surgery 1988; 104(2): 272–9.
26. Saitoh D, Ookawara T, Fukuzuka K, et al. Characteristics of plasma extracellular SOD in burned patients. Burns: journal of the International Society for Burn Injuries 2001; 27(6): 577–81.
27. Sener G, Sehirli AO, Satiroğlu H, Keyer-Uysal M, Yeğen BC. Melatonin improves oxidative organ damage in a rat model of thermal injury. Burns: journal of the International Society for Burn Injuries 2002; 28(5): 419–425.
28. Xie C, Hu J, Cheng Y, Yao Z. Researches on cognitive sequelae of burn injury: Current status and advances. Frontiers in neuroscience 2022; 16: 1026152.
29. Mulder PPG, Vlig M, Fasse E et al. Burn-injured skin is marked by a prolonged local acute inflammatory response of innate immune cells and pro-inflammatory cytokines. Front Immunol. 2022; 13: 1034420.
30. Mulder PPG, Vlig M, Boekema BKHL et al. Persistent Systemic Inflammation in Patients With Severe Burn Injury Is Accompanied by Influx of Immature Neutrophils and Shifts in T Cell Subsets and Cytokine Profiles. Front Immunol. 2021; 29;11: 621222.
31. Dahiya P. Burns as a model of SIRS. Front Biosci (Landmark Ed) 2009; 14(13): 4962-7.
32. Flierl MA, Stahel PF, Touban BM et al. Bench-to-bedside review: Burn-induced cerebral inflammation--a neglected entity? Crit Care 2009; 13(3): 215.
33. Sharma JN, Al-Omran A, Parvathy SS. Role of nitric oxide in inflammatory diseases. Inflammopharmacology 2007;15(6): 252-9.
34. Paul V, Ekambaram P. Involvement of nitric oxide in learning & memory processes. Indian J Med Res. 2011; 133(5): 471-8.
35. Bahdar ZI, Abu-El-Rub E, Almazari R, Alzu'bi A, Al-Zoubi RM. The molecular mechanism of nitric oxide in memory consolidation and its role in the pathogenesis of memory-related disorders. Neurogenetics 2025; 26(1): 22.
36. Susswein AJ, Katzoff A, Miller N, Hurwitz I. Nitric oxide and memory. Neuroscientist 2004; 10(2): 153-62.
37. Chapman PF, Atkins CM, Allen MT, Haley JE, Steinmetz JE. Inhibition of nitric oxide synthesis impairs two different forms of learning. Neuroreport. 1992; 3(7): 567-70.
38. Halm MP, Poquin D, Lestaevel P, Chancerelle Y, Graff C. Brain and cognitive impairments from burn injury in rats. Burns 2006; 32(5): 570-6.
39. Purohit M, Goldstein R, Nadler D et al. Cognition in patients with burn injury in the inpatient rehabilitation population. Arch Phys Med Rehabil. 2014; 95(7): 1342-9.
40. Pandharipande PP, Girard TD, Jackson JC et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013; 369(14): 1306-16.
41. Gupta D, Kaushik D, Mohan V. Role of neurotransmitters in the regulation of cutaneous wound healing. Exp Brain Res. 2022; 240(6): 1649-59.
42. Sadiq A, Shah A, Jeschke MG et al. The Role of Serotonin during Skin Healing in Post-Thermal Injury. Int J Mol Sci. 2018; 19(4): 1034.
43. Chance WT, Berlatzky Y, Minnema K, Trocki O, Alexander JW, Fischer JE. Burn trauma induces anorexia and aberrations in CNS amine neurotransmitters. J Trauma 1985; 25(6): 501-7.
44. Wang Z, Chen L, Rong X, Wang X. Upregulation of MAOA in the hippocampus results in delayed depressive-like behaviors in burn mice. Burns 2017; S0305-4179(17): 30165–1.
45. Krstic M, Jovicic N, Selakovic D et al. Simultaneous Administration of Hyperbaric Oxygen Therapy and Antioxidant Supplementation with Filipendula ulmaria Extract in the Treatment of Thermal Skin Injuries Alters Nociceptive Signalling and Wound Healing. Medicina (Kaunas) 2023; 59(9): 1676.
46. Cramer SC, Sur M, Dobkin BH et al. Harnessing neuroplasticity for clinical applications. Brain. 2011; 134(Pt 6): 1591-609.
47. Zhang QH, Hao JW, Li GL, Ji XJ, Zhou M, Yao YM. Long-lasting neurobehavioral alterations in burn-injured mice resembling post-traumatic stress disorder in humans. Exp Neurol. 2020; 323: 113084.
48. Bramham CR, Messaoudi E. BDNF function in adult synaptic plasticity: the synaptic consolidation hypothesis. Prog Neurobiol. 2005; 76(2): 99-125.
49. Calabrese F, Rossetti AC, Racagni G, Gass P, Riva MA, Molteni R. Brain-derived neurotrophic factor: a bridge between inflammation and neuroplasticity. Front Cell Neurosci. 2014; 8: 430.
50. Guan Z, Fang J. Peripheral immune activation by lipopolysaccharide decreases neurotrophins in the cortex and hippocampus in rats. Brain Behav Immun. 2006; 20(1): 64-71.